application form - tesdaisat.com.ph filetesda-op-co-05-f26 rev. 00 – 03/01/17 technical education...
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TESDA-OP-CO-05-F26
Rev. 00 – 03/01/17
TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY Pangasiwaan sa Edukasyong Teknikal at Pagpapaunlad ng Kasanayan
APPLICATION FORM
UNIQUE LEARNERS IDENTIFIER (ULI):
- - - -
to be filled – out by the Processing Officer
REFERENCE NUMBER :
Qual –
alpha
code
YY Region Province Number Series
Assigned to AC
Number Series
Name of School/Training Center/Company:
Address:
Title of Assessment applied for:
Full Qualification COC Renewal
1. Client Type
TVET Graduating Student TVET graduate Industry worker K-12 OWF
2. Profile 2.1. Name:
SURNAME
FIRSTNAME
MIDDLE NAME
MIDDLE INITIAL
NAME EXTENSION (e.g. Jr., Sr.)
2.2. Mailing Address:
Number, Street Barangay District
City Province Region Zip Code
2.3. Mother’s Name 2.4. Father’s Name
2.5. Sex 2.6. Civil Status 2.7. Contact Number(s) 2.8. Highest Educational Attainment
2.9. Employment Status
Male Single Tel: Elementary Graduate Casual
Female Married Mobile: High School Graduate Job Order
Widow/er E-mail: TVET Graduate Probationary
Separated Fax: College Level Permanent
Others:
College Graduate Self - Employed
Others: ____________ OFW
2.10 Birth date (mm/dd/yy): M M D D Y Y 2.11 Birth place: 2.12 Age:
3. Work Experience (National Qualification-related) 3.1. 3.2. 3.3. 3.4. 3.5. 3.6
Name of Company Position Inclusive Dates Monthly Salary
Status of Appointment No. of Yrs. Working Exp.
(For more information, please use separate sheet)
PICTURE
colored,
passport size,
white
background
Date of Application Applicant’s Signature
4. Other Training/Seminars Attended (National Qualification-related) 4.1. 4.2. 4.3. 4.4 4.5 Title Venue Inclusive Dates No. of Hours Conducted By
(For more information, please use separate sheet)
5. Licensure Examination(s) Passed 5.1. 5.2. 5.3. 5.4. 5.5. 5.6. Title Year Taken Examination Venue Rating Remarks Expiry Date
(For more information, please use separate sheet)
6. Competency Assessment(s) Passed 6.1. 6.2. 6.3 6.4. 6.5. 6.6.
Title Qualification Level Industry Sector Certificate Number Date of Issuance Expiration Date
(For more information, , please use separate sheet)
ADMISSION SLIP
REFERENCE NUMBER :
Name of Applicant:
Tel. Number:
Assessment Applied for:
Official Receipt Number:
Date Issued:
To be accomplished by the Processing Officer
Name of Assessment Center:
Check submitted requirements: Remarks:
Accomplished Self-Assessment Guide
Bring own Personal Protective Equipment
Three (3) pieces colored passport size pictures Others. Pls. specify
Assessment Date:
Assessment Time:
Printed Name & Signature of Processing Officer
Printed Name & Signature of Applicant
Date: Date:
Note: Please bring this Admission Slip on your assessment date.
PICTURE
(Passport
size)
TESDA-OP-QSO-02-F07 Rev.No.00-03/01/17
Reference No.
to be filled out by the Processing Officer
SELF ASSESSMENT GUIDE
Qualification:
Units of Competency Covered:
Instruction:
Read each of the questions in the left-hand column of the chart.
Place a check in the appropriate box opposite each question to indicate your answer.
Can I? YES NO
I agree to undertake assessment in the knowledge that information gathered will only be used for professional development purposes and can only be accessed by concerned assessment personnel and my manager/supervisor.
___________________________________
Candidate’s Name & Signature Date:
Evaluated by: _______________________________
AC Manager
Date:
Qualified for Assessment Not yet Qualified for Assessment
TESDA-OP-CO-05-F31 Rev.No.00-03/08/17
Technical Education and Skills Development Authority
ASSESSMENT AND CERTIFICATION PROGRAM
ATTENDANCE SHEET
(Title of Qualification)
Name of Competency Assessment Center:
Date of Assessment:
No. CANDIDATE’S NAME Reference Number: Signature Assessment Results
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Assessor/s:
__________________________________ Signature over Printed Name
Accreditation Number:_______________
TESDA Representative:
______________________________ Signature over Printed Name
__________________________________ Signature over Printed Name
Accreditation Number:_______________
AC Manager:
______________________________ Signature over Printed Name
TESDA-OP-CO-05-F28 Rev.No.00-03/08/17
Technical Education and Skills Development Authority ASSESSMENT AND CERTIFICATION PROGRAM
LETTER OF APPOINTMENT _______________ Date ___________________ ___________________ ___________________ Dear Sir/Madam: This letter officially appoints you as competency assessor on ___________________ for _______________________________ at ________________________. Please report to the Assessment Center as scheduled. If you have any questions, please call _____________ at _______________. We look forward to your acceptance of this appointment. Very truly yours, ______________________ AC Manager Conforme: _____________________
Signature of Assessor
(schedule of assessment)
( name and address of assessment center
)center)
(contact person) (phone number)
(state title of Qualification)
TESDA-OP-CO-05-F30 Rev.No.00-03/08/17
REQUEST FORM FOR ASSESSMENT PACKAGE/S
TITLE OF QUALIFICATION
NAME OF ASSESSMENTCENTER
DATE OF ASSESSMENT
NUMBER OF CANDIDATES FOR ASSESSMENT
REQUESTED BY (PO CAC Focal)
DATE OF REQUEST
APPROVED BY (Provincial Director)
DATE APPROVED
TESDA-OP-CO-05-F29 Rev.No.00-03/08/17
LETTER OF ASSIGNMENT _________________ Date ___________________ ___________________ ___________________ ___________________:
This letter officially designates you as TESDA Representative on (__Date __) for ( Title of Qualification ) at ( name and address of AC/AV ). Please report to the Assessment Center/Venue as scheduled. If you have any questions/ queries, please call the undersigned at telephone number/s ______________. Very truly yours, ____________________ Provincial Director Conforme: _____________________ Signature over printed name of TESDA Representative
TESDA-OP-CO-05-F34 Rev.No.00-03/08/17
REPORT ON ASSESSMENT PROCEEDINGS
Name of Competency Assessment Center
Accreditation Number
Title of Qualification
Date of Assessment No. of Candidates
Name of Competency Assessor Findings and Observations:
Items Yes No Areas for Improvement
1. Competency Assessor has a signed Letter of Appointment
2. Attendance of the candidates is checked and Admission Slips are verified and collected
3. Supplies and materials are available during the conduct of assessment
4. Tools and equipment are available and in good working conditions
5. Assessment starts on time
6. Conduct of assessment is in accordance with the methods identified in the CATs
7. Projects produced by the candidates are in accordance with the requirements in the CATs.
8. Candidates are provided with clear and constructive feedback on the assessment decision (one-on-one)
9. Assessor has the ability to manage the competency assessment proceedings
10. Complaints of candidates are properly addressed and handled by the Assessor & the AC, when applicable
11. Assessment Packages issued to the Assessor are completely returned upon completion of assessment
12. Assessment-related documents are accurately accomplished and submitted promptly after assessment
Rating Sheets
CARS
Attendance Sheet
RWAC
Application Forms with SAGs
Assessor’s Guide & Specific Instruction to Candidate
Narrative: (Recommended areas for improvement of items which are not covered or named above) Prepared by:
____________________________________ Signature over Printed Name (TESDA Rep)
Date:
_____________________
TESDA-OP-CO-05-F35 Rev.No.00-03/08/17
LETTER OF DESIGNATION
_______________
Date
(Head of TVI/ Company)________
___________________
___________________
Dear ________________:
This letter officially designates __(NAME OF TVI/ Company) as assessment venue
for (TITLE OF QUALIFICATION) on (DATE OF ASSESSMENT). Conduct of
assessment shall be governed by Procedures Manual on Competency Assessment.
We look forward to your acceptance of this agreement.
Very truly yours, Approved by:
___________________ _____________________
AC Manager TESDA Provincial Director
CONFORME:
___________________
Head, TVI/ Company
TESDA-OP-CO-05-F36 Rev.No.00-03/08/17
ASSIGNMENT OF ASSESSORS
For the month of ____________________
QUALIFICATION
TITLE
PROVINCE
NAME OF ASSESSOR ASSESSMENT CENTER DATE OF ASSESSMENT
TESDA-OP-CO-05-F37 Rev.No.00-03/08/17
Performance Evaluation Instrument
Assessor’s Name
Qualification
Name of Respondent Date
Accomplished
[Pls. Tick () where applicable]
ACAC Manager
Candidate
INSTRUCTIONS: Put a tick () mark in the appropriate column
SCALE GUIDE 5– Very Satisfactory 4 – Satisfactory
3 – Good 2 – Fair
1 – Poor
ITEM RATING
5 4 3 2 1
1. Physical appearance and composure (Pangkalahatang anyong pisikal at kung paano magdala sa sarili)
2. Ability to pace instruction (Kakayahang magpaliwanag ng malumanay at mahusay kung ano ang mga dapat gawin)
3. Ability to establish good rapport with candidates (Kakayahang magpadaloy ng komunikasyon sa pagitan niya at ng mga kukuha ng pagsusulit)
4. Ability to ensure that the candidate understands the instruction (Kakayahang siguraduhing ang lahat ng instruksyon ay naiintindihan ng mga kukuha ng pagsusulit)
5. Ability to answer querries, comments, etc. (Kakayahang magbigay ng karapat dapat nasagot o tugon sa mga tanong, puna o mga paglilinaw)
6. Ability to establish the assessment context and purpose of assessment
(Kakayahang magpaliwanag tungkol sa layunin ng pagsusulit)
7. Ability to plan and prepare the evidence gathering process (Kakayahang paghandaan at iayos ang mga pangangailangan sa pagsusulit)
8. Ability to provide allowable/reasonable adjustments in the assessment procedure
(Kakayahang magbigay ng makabuluhang konsiderasyon sa may Mga pangangailangan sa pagsusulit)
9. Ability to conduct assessment in accordance with the methodologies
(Kakayahang ipatupad ang pagsusulit ayon samga itinakdang panuntunan)
10. Ability to collect appropriate evidence during the conduct of assessment
(Kakayahang mangalap at sumuri ng mga tamang ebidensya habang nagbibigay ng pagsusulit
11. Ability to provide clear and constructive feedback on the assessment decision
(Kakayahang magbigay ng malinaw at tamang kaukulang opinyon
sa resulta ng pagsusulit)
12. Ability to provide fair, reliable and valid assessment decision (Kakayahang magbigay ng pantay, ugma at tamang desisyon sa resulta ng pagsusulit)
Sub - score
FINAL RATING
Signature of Respondent
FOR TESDA USE ONLY
EVALUATOR’S REMARKS:
RECOMMENDATION:
For re-accreditation YES
NO For further review
*Frequency
For AC Manager – once a month For Candidate - at least 2 candidates per assessment schedule
TESDA-OP-CO-05-F38 Rev.No.00-03/08/17
UTILIZATION REPORT ON BLANK CERTIFICATES ISSUED
REGION ___________________
Name of Form Quantity Received
Date Received
Inclusive Serial No. Recipient (Province/
District)
Quantity Issued
Inclusive Serial No. Spoilage Available Balance From To From To Qty
Serial No.
Prepared by: Signature: Date:
Certified Correct: (Regional Director) Signature: Date
TESDA-OP-CO-05-F42 Rev.No.00-03/08/17
TRACKING SHEET
PREPARATION AND ISSUANCE OF CERTIFICATE
For the month of ____________________
NAME
TITLE OF
QUALIFICATION
DATE OF
ASSESSMENT
DATE OF
RECEIPT OF
CARS BY THE
PO
DATE OF
PRINTING
OF NC/COC
SIGNATURE OF
CANDIDATE
DATE OF RECEIPT OF
NC/ COC BY THE
CANDIDATE
LAST NAME FIRST NAME MI
Prepared by:
Noted by:
Name & Signature Provincial Director
TESDA-OP-CO-05-F27 Rev.No.00-03/08/17
LETTER OF AUTHORIZATION
I, ________________________, of legal age, Filipino, single/married with
address at____________________________________, do hereby name, constitute
and appoint _____________________________ of legal age, Filipino, single/ married
and with address at ____________________________________, to be my true and
lawful attorney, for me and in my name, place and stead, to perform the following acts
and things, to wit:
1. To claim my Certificate in __________________________________; and
2. To sign all documents necessary for the conduct of said transaction.
Issued on ___________________, 20____ at _____________________. __________________________ Signature of the Certified Worker __________________________ Authorized Representative (Signature over Printed Name)
___________________________________________________________________ For TESDA use only I hereby attest that the claimant presented the following:
Original copy of CARS
Photocopy of ID of the certified worker
Accreditation ID of claimant (if Liaison Officer)
Photocopy ID of claimant
__________________________________ TESDA PO CAC Focal person (Signature over Printed Name)